Paul Tripoli
On the surface, the work performed by direct care workers can be viewed as providing consumers with basic needs: bathing, grooming and other activities of daily living. However, at the deepest level, direct care workers touch the heart of the human being. The emotional component and impact of their work can be profound, as the people they care for — like the caregivers themselves – have a need for self-expression and a need to relate to others.
Transference
In a counseling therapy setting, therapists and their clients often experience what is known as transference and counter-transference, when one of them projects feelings from past relationships onto the other. Transference can lead to a client having romantic feelings for a therapist.
The same process can happen between a direct care worker and someone he or she assists. As Lisa Marie Hilz writes in Transference and Counter-Transference, transference “evolves from unresolved or unsatisfactory…experiences in relationships with parents or other important figures…. This may precipitate behavioral and thought patterns in subsequent relationships, even though certain actions and attitudes may be inappropriate for the current interaction…. As nurses generally have the most consistent and frequent contact with patients as compared with other disciplines, the potential for nurses to be objects of transference is significant.”
It is not uncommon for consumers to feel love, affection, distrust, anger and sexual attraction for direct care workers. After all, consumers are people too. But the expression of sexual feelings can cause awkward moments in the working relationship if the consumer expresses those feelings in words and actions.
A discussion of sexual issues should not necessarily be avoided, as it may offer the consumer an opportunity to discuss their concerns. But when the topic of sex and sexual issues is brought up, the direct care worker must be equipped to establish clear and effective boundaries. The worker must make it clear that any discussion concerning sex or sexual issues is for educational purposes only, with the goal of leading the consumer to further information or possible referral to another professional.
It is not uncommon for a consumer to attempt to make a pass at a direct care worker or request sexual contact, especially during showering/bathing or dressing. Again, the worker must have the professional wherewithal to establish a boundary immediately, letting the consumer know that, while they care about him or her as a person, they will not cross that boundary.
Counter-transference
Direct care workers often have experience counter-transference, or inappropriate feelings for someone they assist. As Hilz writes. “Unresolved conflicts from the nurse’s past may evolve as counter-transference. For example, a patient who displays childlike dependency toward a nurse may evoke a parental attitude from that nurse.”
I have not met too many people who have resolved all of their personal issues, so it’s not surprising that this happens so often. But as professionals, direct care workers must be on the lookout for counter-transference in themselves and know how to handle it when it occurs.
A direct care worker – especially if she works in home care — may be the only person the consumer has meaningful contact with. This is a powerful position to be in, and it might be easy to get lulled into a “power trip” in this situation.
Direct care workers also have to understand their feelings toward the consumers they work with. A good question to ask yourself is why you chose this profession and why you like to provide care for people. The answers may be revealing. If you find that unresolved feelings are causing you challenges in your work, you may want to get those issues addressed by a professional — especially if they involve sexual issues.
This article can only touch briefly on this subject, but it is important that direct care workers go deeper, exploring their personal concerns to make sure that that don’t get in the way of providing good care.
Please consider the following suggestions:
- Write out a purpose statement for yourself, answering the question: What is my purpose in being a direct care worker? Read over your purpose statement several times. Share it with other direct care workers and ask them to do the same. If part of your motivation is wanting to help people be as independent as possible, think about what they means in terms of not allowing the people you work with to become unhealthily dependent on you.
- If you feel that you have strong unresolved issues, seek out professional help.
Paul J. Tripoli, LCSW, LPC, BCD
